Posted by Tomatheus on September 21, 2006, at 9:19:30
In reply to Re: Here's my first and last word(s), posted by SLS on September 20, 2006, at 21:13:48
Scott,
See below for my responses to different sections of your post.
Tomatheus
> We are also lucky to have the me-too drugs. They are not me-me drugs. People respond to Zoloft who don't respond to Prozac and vice-versa.
I think you're right. A true "me-too" drug is one that offers absolutely zero benefits over existing drugs, and so I don't think it's fair to put all of the SSRIs that have come out since Prozac into this category. As you mentioned, there are people who respond to one SSRI but not others, and the SSRIs do vary to some extent in terms of side effects, which gives people with different needs and different comorbid medical conditions more options. The percentage of patients with major depressive disorder who would respond to one SSRI but not one or more of the others is probably rather small (my guess is that it would be in the single digits for any given drug), but as I alluded to in my previous post, the lives of these individuals are no less valuable than those of individuals who are part of a larger minority. Patients who respond uniquely to one SSRI over the others should not be blamed for the fact that some drug companies have apparently decided to forego research on drugs with more novel mechanisms that might benefit individuals with illnesses that statistically show a greater rate of morbidity than MDD. The drug companies could very easily reallocate funds from their marketing and administration budgets or their profits (I know that this isn't likely, but they can do it, and they would if they were true to their word about caring about patients) to the R&D of these highly innovative drugs. So, I question the accuracy of claims that R&D spending on new drugs with similar mechanisms of action as older ones is actually preventing the drug companies from spending the needed dollars on more "innovative" drugs.
> I am soon going to ask to be placed on this mystery compound, and I am not happy to learn all of this.
I'm sorry that I've had to place myself in the position of being the bearer of bad news, in a manner of speaking. I have personally spent a tremendous amount of time researching the Nardil formulation change, and there is little question in my mind that a large majority of veteran responders and probable responders (e.g., those with atypical depression, social anxiety disorder, and/or panic disorder) to the "old" Nardil would have reported the new version as being markedly less effective and less tolerable than the old version if a controlled, randomized study of the two formulations had been conducted. Given the anecdotal reports from veteran "old" responders on the new formulation's reduced effectiveness and facts such as those that I referenced in my previous post, I think that the available evidence strongly points to the likelihood that the "new" Nardil's clinical profile is dramatically different from that of the "old" Nardil. I absolutely hate having to say this, but I wouldn't be claiming with such certainty that the "new" Nardil is clearly less effective and less tolerable than the "old" Nardil if I didn't have overwhelmingly strong evidence to support my assertion.
Having said what I've said, I don't think that the "new" Nardil is completely devoid of therapeutic value in everybody, and I don't think that individuals with treatment-resistant mood and/or anxiety disorders should overlook its potential benefits just because it isn't the "old" Nardil. It is my impression based on posts that I've read on this board and other Internet forums that it is virtually unheard of to respond to the "new" Nardil as monotherapy, but may be possible to respond to the drug as part of a polypharmacological drug cocktail. It is absolutely conceivable that the meds that you're currently taking might work synergistically with the "new" Nardil, so I don't think that the "new" Nardil's reduced effectiveness and tolerability compared with the old formulation is reason to abandon hope that the "new" Nardil might be part of an effective medication strategy. As discouraging as it may seem (probably eliminating any placebo effect that you might have otherwise experienced from taking the "new" Nardil), I think it's important to understand the reality that Nardil isn't what it used to be so you won't be too surprised if, for example, you end up sweating a lot more than you did on the "old" Nardil or start developing back pains at 75 mg of the drug. Besides, I think that if you were a placebo responder, you would have found that out a long time ago.
> No. Neither. I apologize. That was obviously a rant of my own that was not meant to be directed at you personally. I'm sorry that you got caught in the cross-hairs.
Thanks, Scott. I accept your apology. I understand that it's sometimes easy to get carried away when it comes to discussing issues that you feel strongly about because I've been guilty of doing the same thing myself. Despite the fact that I chose to express my disagreement with one aspect of something that you wrote, I actually agree with a vast majority of what you've written on Psycho-Babble, which is part of the reason why I don't typically have much to say in response to your posts (that and the fact that the psychomotor retardation that I experience is sometimes so severe that it makes it next to impossible to compose a coherent post). I've actually learned a lot from reading your posts, and I truly appreciate the work that you do here.
Tomatheus
poster:Tomatheus
thread:686696
URL: http://www.dr-bob.org/babble/20060919/msgs/687862.html